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Does early enteral nutrition compared to late enteral nutrition result in better outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

Based on 14 level 2 studies, we recommend early enteral nutrition (within 24-48 hours following admission to ICU) in critically ill patients

解説

2

Does achieving target dose of enteral nutrition result in better outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

Based on 2 level 2 studies and 2 cluster randomized controlled trials , when starting enteral nutrition in critically ill patients, strategies to optimize delivery of nutrients (starting at target rate, higher threshold of gastric residual volumes, use of prokinetics and small bowel feedings) should be considered

解説

3

Compared to standard enteral feeds, do diets supplemented with arginine and other select nutrients result in improved clinical outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

Based on 4 level 1 studies and 18 level 2 studies, we recommend that diets supplemented with arginine and other select nutrients* not be used for critically ill patients.

解説

4

Does the use of an enteral formula with fish oils, borage oils, and antioxidants result in improved clinical outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

Based on 1 level 1 study and 4 level 2 studies, we recommend the use of an enteral formula with fish oils, borage oils and antioxidants in patients with Acute Lung Injury (ALI) and acute respiratory distress syndrome (ARDS).

解説

5

Compared to standard care, does glutamine-supplemented EN result in improved clinical outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

Based on 2 level 1 and 7 level 2 studies, enteral glutamine should be considered in burn and trauma patients. There are insufficient data to support the routine use of enteral glutamine in other critically ill patients.

解説

6

Does a high fat/low carbohydrate enteral formula influence outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

There are insufficient data to recommend high fat/low CHO diets for critically ill patients.

解説

7

Does the use of a higher protein enteral formula, compared to a lower protein enteral formula, result in better outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

There are insufficient data to make a recommendation regarding the use of high protein diets for head injured and other critically ill patients.

解説

8

Does the use of peptide based enteral formula, compared to a whole protein formula, result in better outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

Based on 4 level 2 studies, when initiating enteral feeds, we recommend the use of whole protein formulas (polymeric) in critically ill patients

解説

9

Do acidified feeds (low pH) compared to standard feeds result in better outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

There are insufficient data to make a recommendation regarding the use of low pH feeds in critically ill patients.

解説

10

Compared to standard practice (placebo), does the routine use of motility agents result in better clinical outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

Based on 1 level 1 study and 5 level 2 studies, in critically ill patients who experience feed intolerance (high gastric residuals, emesis), we recommend the use of a promotility agent. Given the safety concerns associated with erythromycin, the recommendation is made for metoclopramide. There are insufficient data to make a recommendation about the use of combined use of metoclopramide and erythromycin

解説

11

Does enteral feeding via the small bowel compared to gastric feeding result in better outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

Based on 11 level 2 studies, small bowel feeding compared to gastric feeding maybe associated with a reduction in pneumonia in critically ill patients. In units where obtaining small bowel access is feasible, we recommend the routine use of small bowel feedings. In units where obtaining access involves more

解説

12

Do alterations in body position result in better outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

Based on 1 level 1 and 1 level 2 study, we recommend that critically ill patients receiving enteral nutrition have the head of the bed elevated to 45 degrees. Where this is not possible, attempts to raise the head of the bed as much as possible

解説

13

Does the addition of Prebiotics/Probiotocs/Synbiotics to enteral nutrition result in better outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

There are insufficient data to make a recommendation on the use of Prebiotics/Probiotics/Synbiotics in critically ill patients

解説

14

Does continuous administration of enteral nutrition compared to other methods of administration result in better outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

There are insufficient data to make a recommendation on enteral feeds given continuously vs. other methods of administration in critically ill patients.

解説

15

Does the type of lipids in parenteral nutrition influence outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

here are insufficient data to make a recommendation on the type of lipids to be used in critically ill patients who are receiving parenteral nutrition.

解説

16

Does the presence of lipids in parenteral nutrition affect outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

Based on 2 level 2 studies, in critically ill patients who are not malnourished, are tolerating some EN, or when parenteral nutrition is indicated for short term use (< 10 days), withholding lipids high in soybean oil should be considered. There are insufficient data to make a recommendation about withholding lipids high in soybean oil in critically ill patients who are malnourished or those requiring PN for long term (> 10 days). Practitioners will have to weigh the safety and benefits of withholding lipids high in soybean oil on an individual case-by-case basis in these latter patient populations.

解説

17

Does tight blood sugar control result in better outcomes in the critically ill adult patient?

補足（例文と訳など）

答え

We recommend that hyperglycemia (blood sugars > 10 mmol/L) be avoided in all critically ill patients. Based on the NICE-SUGAR study and a recent meta-analysis, we recommend a blood glucose target of around 8.0 mmol/L (or 7-9 mmol/L), rather than a more stringent target range (4.4 to 6.1 mmol/L) or a more liberal target range (10 to 11.1 mmol/L).

解説

18

Does the addition of supplemental antioxidant combined vitamins and trace elements result in better outcomes in the critically ill patient?

補足（例文と訳など）

答え

Based on 3 level 1 and 13 level 2 studies, the use of supplemental combined vitamins and trace elements should be considered in critically ill patients.

解説

19

Does parenteral selenium supplementation (alone or in combination with other antioxidants) result in better outcomes in the critically ill patient?

補足（例文と訳など）

答え

There are insufficient data to make a recommendation regarding IV/PN selenium supplementation alone, or in combination with other antioxidants, in critically ill patients.